ER CARE IS NOT CAUSE OF HIGH HEALTHCARE COSTS, HARVARD STUDY SAYS

Medicare patients under 65, according to a study of 169 newspaper ads, ads on 129 TV stations, and 21 HMO marketing seminars in four U.S. cities. Over 50% of the TV ads featured seniors running, biking, playing with grandchildren, etc. None of the TV or print ads showed people in hospitals or using walkers, and one-third of the seminars were not wheelchair-accessible. Important information
about benefits restrictions was in fine print too small for many seniors to read, and the information often confused even trained researchers. Only one ad was in Spanish, despite large Spanish-speaking populations in three of the four cities studied (Los Angeles, Miami, New York, and Cleveland). Eight ads erroneously claimed that the Medicare beneficiary had to be 65 to qualify for the HMO. For copies, call the Kaiser Medical Policy Project at 1-800-656-4533
and ask for report #1417.

Congress Watch: Bipartisan Failure on Health Care

None of the "patient protection" bills in Congress includes the right to health care,
which is Article XXV of the Universal Declaration of Human Rights. 1998 is the 50th anniversary of the U.N.'s Declaration, which has never been ratified by the United States.

The GOP apparently wants to end employer contributions to health coverage, including
Medicare. House Ways and Means Health Subcommittee Chair Bill Thomas (R-CA) said the President's Medicare Commission should consider "radical" approaches. Thomas is pushing a proposal that would eliminate the tax break employers receive for purchasing health care for their workers and give individuals a "refundable tax credit" for purchasing their own insurance (Health Legislation, 6/3/98). Representative Newt Gingrich (R-GA) is "enthusiastic" about the Thomas Plan. Gingrich proposed examining the "wisdom of having employers provide health insurance" at a conference of HMO executives earlier this year (Boston Globe, 2/25/98). Phil Gramm (R-TX) "proposes replacing the existing payroll-funded Medicare program with a mandatory savings plan requiring all Americans to maintain [MSAs]" (Washington Times, 3/6/98).

AMA

The AMA's new health policy fits well with the GOP's pitch to cut business' responsibility
for providing health insurance to workers. The AMA decided at their last meeting to make "an all-out effort" to make individuals responsible for buying their health insurance with defined contributions from employers, much like the federal employees health benefits plans (FEHBP)(New York Times, 6/18/98). Under the AMA's proposal, most workers are likely to be pushed into cut-rate HMOs with only the highest-paid employees able to afford better coverage. The AMA is also pushing MSA's (medical savings accounts) as a way of creating a new funding stream for care from affluent patients.

The AMA gave $4.1 million to candidates in the 1996 election, with most of the money going to pro-tobacco congressmen. The AMA contributed an average of $5,382 per pro-tobacco representative, and $2,103 to anti-tobacco members. Pro-tobacco candidates almost always endorse malpractice caps, hence attracting more AMA donations (Sharfstein, AJPH, 8/98).
The cigarette industry spent $40 million on the final three months of its campaign against
the tobacco bill (Los Angeles Times, 6/19/98). The House Commerce Committee posted about 39,000 once-secret tobacco industry documents online at http://www.house.gov/commerce/TobaccoDocs/documents.html. How long before we see a similar site for proprietary medical and utilization review guidelines and insurance company documents?

Public Opinion

A survey of 600 Americans on President Clinton's policy stances found that only 26% were
able to correctly identify that Clinton "favored adjustments to the existing system of private insurance in order to give more people access to the system." A much higher percentage (59%) erroneously thought Clinton "promoted a universal system of national health insurance," a position he never advocated. Similar misunderstandings of Clinton's policies were evident in other areas (e.g., only 13% knew he signed the Republican Welfare Reform Bill). The study found that the public consistently perceives Clinton as being more liberal than the positions he actually takes, perhaps explaining his enduring popularity in the face of ongoing scandals (Extra, May/June 1998).

An NBC/Wall Street Journal poll of 2,006 adults in June found that "the most important health
care issue at the present time" is "people without health insurance" (37%), which was ranked first more frequently than the other two choices of "the cost of health care" (29%) and "the quality of health care" (23%).

Overall, twice as many people thought HMOs were "generally" a "change for the worse"
(40%) than thought HMOs were a "change for the better" (20%). An even higher margin reported that HMOs made the "quality of health care services worse" (41%) versus "improved the quality of health care" (16%). The survey also found that more than two-thirds of Americans say the government should guarantee everyone the best and most advanced health care that technology
can supply, and that "everyone should have access to health care services." There was about an "equal split" over whether the federal government should guarantee access to everyone, even if it means an extra $2,000 in annual taxes for Americans. Democrats, women, and minorities were more in favor, while Republicans, men and whites were less in favor of the increase in taxes (which is substantially higher than what would be required by single payer). A sizable majority believe that "the amount of money people pay for health care should be based on their ability to pay" (Wall Street Journal, 6/25/98).